Influence of intensive asparaginase in the treatment of childhood non-T-cell acute lymphoblastic leukemia.
Influence of intensive asparaginase in the treatment of childhood non-T-cell acute lymphoblastic leukemia.
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发表时间：
1983-11
期刊：
影响因子：
11.2
通讯作者：
S. Sallan;S. Hitchcock-bryan;R. Gelber;J. Cassady;E. Frei;D. Nathan
中科院分区：
文献类型：
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作者：
S. Sallan;S. Hitchcock-bryan;R. Gelber;J. Cassady;E. Frei;D. Nathan
在1977年6月至1979年12月间，72例可评估的儿童非t细胞急性淋巴细胞白血病患者使用长春新碱、强的松和阿霉素诱导完全缓解。所有患者均接受了天冬酰胺酶巩固和中枢神经系统预防，包括颅脑照射和鞘内甲氨蝶呤。然后，所有患者接受长春新碱、强的松和阿霉素的延长强化治疗，其中一半随机接受每周高剂量天冬酰胺酶治疗。继续治疗是长春新碱、强的松、甲氨蝶呤和6-巯基嘌呤。中位随访57个月后，有4例缓解期死亡，25例复发。中枢神经系统复发是4%患者的第一事件。天冬酰胺酶治疗组治疗失败较少[双侧，p = 0.04（对照标准组和高危组为0.07）]。天冬酰胺酶毒性发生在6例（8%）患者中，并且是自限性的，但它排除了这些患者进一步使用该药。该治疗方案的主要毒性是药物性心肌病，发生在10例患者中（14%），其中3例死亡。总之，我们得出结论，高剂量天冬酰胺酶的强化使用在儿童急性淋巴细胞白血病的治疗中具有重要作用。在标准风险患者中，多剂量阿霉素的发病率超过了其抗白血病的优势。
Between June 1977 and December 1979, 72 evaluable patients with childhood non-T-cell acute lymphoblastic leukemia were induced into complete remission using vincristine, prednisone, and doxorubicin. All received asparaginase consolidation and central nervous system prophylaxis with cranial irradiation and intrathecal methotrexate. All patients then received prolonged intensification with vincristine, prednisone, and doxorubicin, and half of them were randomized to receive weekly high-dose asparaginase. Continuation therapy was with vincristine, prednisone, methotrexate, and 6-mercaptopurine. After a median follow-up of 57 months, there were four remission deaths and 25 relapses. Central nervous system relapse was the first event in 4% of patients. There were fewer treatment failures in the asparaginase-treated group [2-sided, p = 0.04 (0.07 controlling for standard and high-risk groups)]. Asparaginase toxicity occurred in six patients (8%) and was self-limited, but it precluded further use of the drug in those patients. The major toxicity of this treatment program was drug-induced cardiomyopathy which occurred in 10 patients (14%) and was fatal in three of them. In summary, we conclude that the intensive use of high-dose asparaginase has an important role in the treatment of children with acute lymphoblastic leukemia. The morbidity of multiple doses of doxorubicin outweighed its antileukemic advantage in standard-risk patients.